The past decade has witnessed a revolution in facial plastic surgery, particularly in the management of the aging face. In the past, the facelift represented the principal method of facial rejuvenation, which could only serve to restore the lower third of the face. The traditional browlift that addresses the upper third of the face involved a wide coronal incision that left patients with protracted or permanent scalp anesthesia, lingering edema, potential alopecia, and occasionally unsightly scarring. The midface was uncharted terrain until recently. Techniques now have evolved to provide global rejuvenation of the face without an extended healing period. This book outlines the latest surgical strategies that exist to rejuvenate the face. Although many advances in surgical techniques have proven their efficacy over time, other novel approaches that have failed to withstand the test of time have been abandoned. The surgical techniques that are covered in this book are not untested methods but reflect the extensive clinical experience that has validated the procedures described herein.

Incisional-based surgery only constitutes one strategy for facial rejuvenation today. The surgeon need not brandish the scalpel as the only weapon in the fight against aging. Cutaneous resurfacing is integral to facial restoration for those patients who require this form of intervention either in combination or apart from incisional surgery. Chemical exfoliation represents the oldest method of skin resurfacing and has regained popularity; the luster of laser therapy has been tarnished somewhat by the accompanying lengthy erythema and recovery time. Nevertheless, carbon dioxide (CO₂) laser resurfacing still has its role in the treatment of more recalcitrant rhytids, particularly in the perioral region. Mechanical dermabrasion also exhibits unique properties that make it effective in certain circumstances, such as deep acne scarring or post-scar revision management. This book covers the different treatment modalities separately—laser, chemical, and mechanical—and then addresses how to combine these techniques effectively in the apposite setting. Recently, the new technology of nonablative resurfacing has arisen as an alternative method to efface mild to moderate rhytidosis; and the results of research that the authors have conducted reveal remarkable histologic improvement. The chapter endeavors to guide the reader in the selection of a suitable candidate who will benefit from nonablative laser or light therapy. The topic of basic skin care is reviewed at the conclusion of this chapter; every cosmetic surgeon should have at least a rudimentary knowledge of this subject so that he or she can reasonably respond to patients’ queries. Also, safe and effective skin care is a fundamental concern in the postresurfacing period, and the physician should be able to navigate the patient through this often-trying time.